Phil Bryant Continues Distorting Health Care Law

Governor Phil Bryant's lack of education about the Affordable Care Act strikes again. In an interview with the Associated Press, Bryant shows that he prefers to live in his fantasy land where the voices of the Tea Party keep him in a constant state of frenzy.

During the AP interview, Bryant said he thought if Mississippi had a state-run exchange, the navigators could unilaterally decide to sign people up for Medicaid, even if they earn too much money to qualify.

Regardless of the fact that the Legislature has not expanded Medicaid?

"Regardless of what the Legislature would have said," Bryant said.

But how would that be possible?

"I have gotten no assurances that that would not be the case," Bryant said.

What Bryant suggests is that anyone can sign up for Medicaid even if he or she does not qualify. If he stands by his own logic, if one wishes to call it that, 100 percent of Mississippi could be signed up for Medicaid regardless if we have a federal or state-run health insurance marketplace. Why, then, haven't we seen a flood of Mississippians overwhelming the Division of Medicaid's computers with three million applications for enrollment? Because it cannot legally happen. By now, we know that during the special session a few months ago, the Tea Party-led House of Representatives went on record rejecting an attempt to expand Medicaid.

At an event in Jackson this past Friday, workers at the Jackson-Hinds Comprehensive Health Center spent the day enrolling individuals and families into private health insurance plans. There were no mentions that those who attended the event were signed up for Medicaid. In fact, according to the Clarion-Ledger article, those who attended were excited about the opportunity to enroll in their own private health insurance plan.

It is no secret that Governor "No Assurances" Bryant does not care for the Affordable Care Act. His track record of false statements and inaccuracies is well documented. A search of this site will give you plenty of examples to review. Still, it is stunning to see and hear what Bryant is making up in order to discredit the Affordable Care Act.

Bryant's paranoia is progressing to the point of suggesting that the Executive Director of Medicaid, his own appointee, would agree to break the law in order to have ineligible persons become beneficiaries. Bryant should find some comfort in knowing that mental health services are considered an Essential Health Benefit under the Affordable Care Act. Whether he will believe it is up to him.

Politico: "Mississippi's Medicaid Plan May Fail"

In today's edition of Politico, Kyle Cheney, writes about the ongoing battle struggle floundering of responsibility from Governor Bryant over the seemingly obvious decision to expand Medicaid.

There are a couple of good quotes here, some that have become old-hat in these parts, including that of House Minority Leader, Rep Bobby Moak:

The federal government will pay for expansion for the first three years, then gradually scale back to paying 90 percent of the cost.

“I feel confident that the members of the House will make a decision that’s best for their district,” Moak said.

As well as industry leaders that see the need:

Mississippi has the most to gain from Medicaid expansion. Conversely, we also have the most to lose,” said Roy Mitchell, executive director of the Mississippi Health Care Access Program. “We’re at the bottom of all the health indicator lists. If we do not expand Medicaid, we will solidify our place at the bottom for at least a generation to come.”

 Hospitals and nursing homes, too, are fretting.

“We continue encouraging Mississippi legislators to come to an agreement quickly to fund the existing Medicaid program beyond June 30, so it does not cause any disruption in services to our nursing home residents,” said Vanessa Phipps Henderson, executive director of the Mississippi Health Care Association.

National eyes are on our state to do the right thing for its people, especially since so many partisan Republicans have already seen the writing on the wall. 

How far will Governor Bryant go to avoid giving Democrats a political victory?

And does he know that his actions could lead to his state's long term defeat?

Mississippi Republicans and their big, nasty Medicaid problem

The Mississippi GOP is furiously spinning, trying to place the blame on Democrats for ending the legislative session without funding Medicaid for FY2014.  Instead, they should be working on a solution to the problem.

Alan Lange over at YallPolitics.com has an article up outlining his fantasy for how Republicans should approach the problem, and it reads like he's working out some issues related to PHDD (Post-Haley Departure Disorder). In his world, Democrats are to blame for not voting to reauthorize Medicaid and moving on.  He's just ignoring basic facts.

The House Republican leadership killed the last Medicaid reauthorization bill available (which the Republican-led Senate passed) by assigning it to the Rules Committee and not letting it onto the floor.  Democrats never got the chance to even debate that bill, let alone vote it down.  Under Lange's proposed plan of action, the Gov. Bryant would create a very narrow call for the special session and only allow a bill that would prevent Medicaid expansion.  Well, the problem with that approach is that, while the governor certainly may limit the scope of a special session, he cannot issue a "take it or leave it" piece of legislation for the Legislature to either pass as is or reject.  The Legislature has the power to amend the proposed legislation, as was established in the medical liability reform special session of 2002.

Next, Lange starts to bang the keys a bit more loudly:

I would literally call a special session every two days. I’d make them come to Jackson and then go back home and then come back to Jackson. Lather, rinse and repeat. If I were feeling especially evil, I would make sure that the air conditioning at the Capitol is not working. 

Do you remember when Republicans used to complain about the costs associated with special sessions?  I do.  But I guess our economy's been booming since they took over, so we don't have to worry about stuff like that any more.  Oh, wait....

There's a reason there hasn't been a vote on expanding Medicaid: House Republicans are too scared to get on the record about it.  They know full well that the Tea Party folks in their districts are foaming at the mouth over anything associated with President Obama, especially "Obamacare".  They also know full well that those same folks won't have a hospital to go to at all if expansion in some form isn't passed.

It's times like these when the people of Mississippi expect their governor to lead, not bloviate.  Nearly every other Republican governor in the country is looking to work some sort of compromise on Medicaid expansion so that their states can receive the economic benefits of the Affordable Care Act.  But not our governor, Dr. Phil!  He's too busy saying that poor people are lazy and don't really need to see the doctor anyway and drawing lines in the sandbox he had installed for his enjoyment over at the Governor's Mansion.  (That's a joke; he didn't really build a sandbox to play in.)

Mississippi Republicans can keep on spinning all they want, but there's no way they don't take the hit for the current Medicaid problem: they control every branch of government totally.  Furthermore, reauthorizing Medicaid without expanding it doesn't solve the problem of hospitals closing.  Medicaid expansion is the new way the federal government has decided to handle the problem of uncompensated care, whether anyone likes it or not.  Reauthorize Medicaid without expanding it?  Don't even bother.  The hospitals simply aren't going to make it without DSH payments, which are going away.

The only real option left is for them to begin to work towards a compromise under which we accept the federal funds (which are going somewhere anyway, mind you).  Gov. Bryant needs to begin working with legislative Democrats and the hospital community to find an agreeable solution that allows the hospitals to stay open through Medicaid expansion.  He's got until July 1.

Where does Gov. Phil Bryant stand on renewed Personhood Amendment?

Back during the 2011 campaign, Gov. Phil Bryant (R) gave us one of the more memorable quotes of the year.  On the eve of Election Day 2011, Bryant was asked about the Personhood Amendment, which was to be on the ballot the following day.  Bryant said that if voters failed to approve the Personhood Amendment, then "Satan wins."

Well, Satan went on to have a resounding victory the next day, with 58% of Mississippi voters being so overcome by Lucifer that they voted against Personhood, which would have made in vitro fertilization and most methods of birth control illegal in Mississippi.

(One wonders which spirit Bryant feels moved the 61% of the electorate that voted for him, especially considering the statistical certainty that a large number of people who voted for him fell victim to Beelzebub that very same moment and cast a ballot against his beloved Personhood Amendment.)

Tuesday, the folks behind 2011's Personhood Amendment filed paperwork to put it back on the ballot in 2015. Les Riley, who has been linked to secession movements in the past, is once again heading up the Personhood Amendment efforts, and said in a news conference Tuesday that Mississippians were just "confused" back in 2011.

So the question becomes:  Where are you, Dr. Phil, on this issue? How long will we have to wait for your guidance on the issue of Personhood?  Will you once again call the majority of us Satan's minions?  We'll be counting the days.

Gov. Bryant in full-on meltdown mode over Medicaid expansion

I was right.  Yesterday, I wrote the following:

Well, in a sane world, this would be checkmate.  Mississippi Democrats in the Legislature held a press conference this morning to discuss a letter they sent to Gov. Phil Bryant (R) regarding his concerns over Medicaid expansion, and offering a compromise.
...
But it won't be.  After all, our governor thinks if you're not rich like him, you're a no-good, lazy, layabout who doesn't deserve health care in the first place.  Go, Mississippi, keep rolling along....

Like clockwork, here comes Gov. Bryant this morning in the Clarion-Ledger, flailing around like a bass on the bottom of a jon boat:

The first thing I’d do is sue (the federal government),” Bryant said Wednesday after state House Democratic leaders offered what they call a compromise to the governor and House GOP leadership on Medicaid expansion.

Never mind the fact that members of his own party have said that the litigation over the Affordable Health Care Act is finished, here goes Gov. Don Quixote tilting at windmills.

But that's not even the interesting part about what he said yesterday.  Gov. Bryant went on to decry the Medicaid system in Mississippi as replete with waste:

"I do not see expansion of Medicaid in Mississippi as it exists today, with all its waste, fraud and abuse,” Bryant said.

Let's play a game.  Which of the following do you think Gov. Bryant will have brought to his attention first by his staffers:

1. That, as Governor, he is actually in charge of the Medicaid system he just said was full of "waste, fraud, and abuse", or 
2. That he just called the doctors, nurses, and hospitals of Mississippi a bunch of frauds?

We have almost three more years of this, y'all.

Anatomy of a legislative murder, or how Gov. Bryant and Speaker Gunn are killing Medicaid

This is a somewhat technical post, and I apologize for that, but it's important to understand this bit of legislative procedure so that you can be informed on the state of play in Mississippi regarding Medicaid expansion.

Background


First, under Rule 35 of the House Rules, amendments that concern code sections not in the legislation as introduced are improper.  For example, if a bill is before the House that seeks to change language in Section 97-3-7 of the Mississippi Code, a House member could not offer an amendment to the bill that would change language in Section 97-3-5.  The Senate has no such rule.

Second, many of our state-level governmental departments are creatures of statute, and most state statutes that create governmental departments have "repealers" in them.  Repealers are sentences that set a date upon which the governmental entity in question loses its statutory authority to exist.  The statutes creating the Department of Medicaid have repealers in them, and they dictate that the Department of Medicaid will cease to exist on July 1, 2013.  That means the Legislature must pass, and Gov. Phil Bryant must sign, a bill that would change the language of the repealer before July 1.  (The idea that the governor can run Medicaid through executive order is one that has already been decided in the negative, thanks to Gov. Barbour attempting to do that back in 2006.)

Finally, a bit on the legislative process as a whole.  A bill begins its process in the Legislature when it is drafted by legislative staff at the request of a legislator.  Once the bill has been drafted, it is introduced and assigned to a committee by the leader of the chamber (either Lt. Gov. or Speaker).  The bill then has to be passed out of the committee to which it has been assigned in order to be considered on the floor of the originating chamber.  If passed by the originating chamber, it is then transmitted to the other chamber, where it is assigned to a committee (again by the leader of that chamber).  The bill then has to pass that committee before being considered on the floor of the other chamber.

So that's the background, now here's how all of that affects Medicaid expansion in Mississippi.

Medicaid Money & Dr. Phil: Asking for Answers but Avoiding the Questions

This weekend, the Northeast Mississippi Daily Journal ran opposing opinions from Governor Phil Bryant and Senator Hob Bryan (D-Amory) regarding Medicaid expansion in our state. You can read each of them by clicking on their respective links. They are both worth a detailed read.

A major new talking point of Governor Bryant’s excuse for avoiding expansion is that the we should not hurry into accepting the prospects of Medicaid expansion, and that we must discuss our options thoroughly, saying:

Let me assure you, expanding the Medicaid program will have huge implications for this state’s budget, affecting you, your children and even your grandchildren. At a minimum, the decision should not be rushed.

It seems obvious that expanding Medicaid will have huge implications, namely extremely positive ones such as better health care for Mississippians and strengthened programs in our private medical industry.

But Senator Bryan quickly responded today with another important point:

Gov. Phil Bryant says the legislature should reauthorize the division of Medicaid and wait until we have more information before making a decision about expanding the program. The state Senate unanimously voted to do that very thing, but Speaker Phillip Gunn – with the support of the governor – had our proposal sent to the house rules committee to be killed. Apparently Gov. Bryant and Speaker Gunn feel they don’t need any more information.

Lastly, Senator Bryan acknowledged a fact that Governor Jan Brewer (R-Arizona), Governor Rick Scott (R – Florida), and Governor John Kasich (R-Ohio) already know. Medicaid expansion is going to occur. Are we going to pay for other states to do it, or are we going to control our own destiny?


I suspect Governor Bryant already knows the answer to that, too. But he keeps avoiding the question.

Dr. Phil & "Playing Politics"

Yesterday, Mississippi House Democrats warded off an attempt to deny the state a shot at Medicaid expansion. In a move to kill the expansion option, a bill was introduced to extend the current Medicaid plan beyond its current deadline.

Emily Wagster Pettus (Associated Press) reports that Minority Leader Moak and others saw through the plan:

The House Democratic leader, Rep. Bobby Moak of Bogue Chitto, urged party members to vote against the Medicaid reauthorization bill Thursday because it could not be changed to add Medicaid expansion. He said a Senate bill could be amended later. There's a technical reason the House bill couldn't be amended: It doesn't contain the right sections of state law, and House rules prohibit adding sections that aren't in the original draft.

According to Rep. Moak, Medicaid expansion could add up to 9,000 new jobs for the state, and would provide health care for thousands of Mississippians with little to no help.  Yet Governor Bryant insists that the Democrats are the ones playing politics with Mississippians' health.

More from AP:

 "I am certainly prepared to run Medicaid by executive order to prevent nursing home patients and aged, blind and disabled adults from losing services," Bryant said in a news release Thursday. "I believe the Democratic leadership's threatening the care of vulnerable citizens to advance a political agenda is shameful."

But as we know, "Dr. Phil" believes that anyone who needs health care already has it.

So which one is it? Do Mississippians need access to these services or not?

Introducing: Dr. Phil

For your viewing pleasure:

Get this man a TV show

More Dr. Phil, only this time more insulting!

Straight from the interview with Kaiser Health News:

BRYANT: I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to pay for additional Medicaid recipients. Medicaid recipients multiply their visits to a physician. It’s clear once someone goes on Medicaid, the number of times they go to a physician doubles, quadruples.  

KHN: Some experts may argue people new to Medicaid have many health issues they need to address.

BRYANT: I make the argument that it’s free. It’s free and you have nothing else to do.

And to think, we were embarrassed by Congressman Steven Palazzo's vote on Hurricane Sandy relief.

"Dr. Phil" Strikes Again: Gov. Bryant on the state of American healthcare

I mean, Lord.  I'll let our illustrious Gov. Phil Bryant (R) explain himself on why we don't need healthcare reform:

There is no one who doesn't have health care in America. No one. Now, they may end up going to the emergency room. There are better ways to deal with people that need health care than this massive new program.

That's from an interview with Kaiser Health News released today.  Jeffrey Young, Huffington Post Health Care reporter, immediately jumped on it and put together a wonderful piece.  In it, Young goes squarely after the idea that "Dr." Phil Bryant put forward:

In 2011, 48.6 million Americans had no health insurance, according to the most recent census data. Among those who do have coverage, many still can't afford medical care so they skip it. The truth is, there's a health care access problem and it's been getting worse. And Mississippi has the fifth-highest rate of uninsured residents in the nation: 19 percent.

That's all fine and good if you're a bleedin' heart lib-ruhl and everything, but what about the good ol' rock-ribbed conservative "screw the poors" side of this deal?

Funneling uninsured, "underinsured," and poor people to emergency rooms isn't great for the hospitals, either. Hospitals absorbed $41.1 billion in unpaid bills (known in the business as "uncompensated care") in 2011, according to a report issued by the American Hospital Association this month.

In fact, the Mississippi Hospital Association has come out in favor of Medicaid expansion to help cover the cost of uncompensated care:

The predicament is about to get worse for hospitals in states that don't expand Medicaid under Obamacare. Medicare and Medicaid currently provide extra money to facilities that treat a disproportionate share of patients who can't pay their bills. The health care law makes significant cuts to those funding streams -- because more people are supposed to get private health insurance or Medicaid starting next year. Based on this calculation, the American Hospital Association and other national industry lobbying groups endorsed the health care overhaul. 

The hospitals in Bryant's home state see things the same way: The Mississippi Hospital Association backs the Medicaid expansion. Not broadening Medicaid would "be devastating," the association said in a statement last June. "Hospitals cannot be expected to treat such a large volume of people with no expectation or prospect of payment for those services. The result could very well mean the closure of many of our community hospitals."

But yeah, don't worry about the closing hospitals.  Ashley Furniture just added 60 jobs in Verona, don't you know!  Those doctors can just go work there.